The Clinical Physics Aspects Behind DICOM-RT, Germond

8/9/2019 The Clinical Physics Aspects Behind DICOM-RT, Germond

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Service dOncologie-Radiothrapie de lHCF

The clinical physics aspectsThe clinical physics aspectsbehind DICOMbehind DICOM--RTRT

JeanJean--FranoisFranois GermondGermond

ServiceService dOncologiedOncologie--RadiothrapieRadiothrapie

HpitalHpital de Lade La ChauxChaux--dede--FondsFonds


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DICOMDICOM--RT for physicistsRT for physicists

DICOM normative terminologyDICOM normative terminology

DICOM WorkflowDICOM Workflow

Physical interpretation of DICOM attributesPhysical interpretation of DICOM attributes


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DICOM normative terminologyDICOM normative terminology

DICOM WorkflowDICOM WorkflowDICOM Workflow

Physical interpretation of DICOM attributesPhysical interpretation of DICOM attributesPhysical interpretation of DICOM attributes


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DICOM dictionaryDICOM dictionaryTag value Type VR Attribute name Examples

(0010,0010) 2 PN PatientsName Germond^Jean-Franois^^Dr^Physicist

(0010,0020) 2 LO PatientID Hospital patient UID

(0010,0030) 2 DA PatientsBirthDate 19460610

(0010,0040) 2 CS PatientsSex M or F or O

(300A,0002) 1 SH RTPlanLabel Plan 1

(300A,00B2) 2 SH TreatmentMachineName Precise

(300A,00C6) 2 CS RadiationType PHOTON or ELECTRON

(300A,00B8) 1 CS RTBeamLimitingDeviceType ASYMX or ASYMY or MLCX

(300A,00C0) 1 IS BeamNumber 1

(300A,00C4) 1 CS BeamType STATIC or DYNAMIC

(300A,011E) 1C DS GantryAngle 0 - 359

(300A,0120) 1C DS BeamLimitingDeviceAngle 0 - 359

(300A,011C) 1C DS LeafJawPositions -50.0\ 50.0 for a 10 cm field size

(300A,0114) 3 DS NominalBeamEnergy In MV or MeV

(300A,0086) 3 DS BeamMeterset = number of MUs for the beam

Demography

ANSI


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Plan

X cross-plane

Y

in-plane IEC 61217


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Beam

IEC 61217

mm


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DICOM normative terminologyDICOM normative terminologyDICOM normative terminology

DICOM WorkflowDICOM Workflow

Physical interpretation of DICOM attributesPhysical interpretation of DICOM attributesPhysical interpretation of DICOM attributes


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DICOM SOP topologyDICOM SOP topology @ HCF@ HCF

CT/ PQ5000 VoxelQ/ AcQplan

HDR/Nucletron

EPID/ iView Linac/ Precise

Imager/ Kodak

CT/SC imagePrint Management

RT PlanStorage

CT imageStorage

Router

RT Plan/ImageStorage

SC ImageStorage

RT ImageStorage

RT PlanStorage

PMS

EOS


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DICOMDICOM SSOP topologyOP topology @ HCF@ HCF


HDR/Nucletron


Imager/ Kodak


RT PlanStorage

CT imageStorage

Router


SC ImageStorage

RT ImageStorage

RT PlanStorage

PMS

EOS

DICOM Service


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The DICOM storage serviceThe DICOM storage service

1.1. Data are extracted from the DB of modality AData are extracted from the DB of modality A

2.2. These data are inserted into a DICOM objectThese data are inserted into a DICOM object

3.3. Modality A initializes an association with modality BModality A initializes an association with modality B

4.4. The DICOM object is sent to modality BThe DICOM object is sent to modality B

5.5. Specific data are extracted from the DICOM objectSpecific data are extracted from the DICOM object

6.6. These data are stored into DB of modality BThese data are stored into DB of modality B

Mapping

Mapping


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HDR/Nucletron


Imager/ Kodak


RT PlanStorage

CT imageStorage

Router


SC ImageStorage

RT ImageStorage

RT PlanStorage

PMS

EOS

DICOM Object

DICOM SDICOM SOOP topologyP topology @ HCF@ HCF


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RT Workflow @ HCFRT Workflow @ HCFPQ5000 AcQSim AcQplan Router Precise linac iView ACTORS

AcquisitionCT-image

Therapist

ROI's drawingRT-StructureSet

Doctor

MLC fieldsRT-Plan

Doctor /Physicist /Dosimetrist

DRR'sRT-Image

Therapist

QA + ArchivingRT-Image

Auto / Physicist

Dose calculationRT-Dose

Physicist /Dosimetrist

QA + ArchivingRT-Plan

Auto / Physicist

TreatmentRT-TrtRecord

Therapist

Details published in Cancer/Radiotherapy 5 (2001) 172s-180s

VerificationRT-image

Therapist /Doctor/Physicist


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PQ5000 AcQSim AcQplan Router Precise linac iView ACTORS

AcquisitionCT-image

Therapist


Doctor

MLC fieldsRT-Plan


DRR'sRT-Image

Therapist


Auto / Physicist




Auto / Physicist


Therapist




= information flowXT-Xxxx = DICOM objects

RT Workflow @ HCFRT Workflow @ HCF


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DICOM normative terminologyDICOM normative terminologyDICOM normative terminology

DICOM WorkflowDICOM WorkflowDICOM Workflow

Physical interpretation of DICOM attributesPhysical interpretation of DICOM attributes


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= information flow


AcquisitionCT-image

Therapist


Doctor

MLC fieldsRT-Plan


DRR'sRT-Image

Therapist


Auto / Physicist




Auto / Physicist


Therapist





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CT Image acquisitionCT Image acquisition

Serie of objectsSerie of objects

CTCT--ImageImage=> Virtual patient=> Virtual patient


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Entity Name Module Name Usage

Patient Patient MStudy MStudy

Patient Study U

Series General Series M

Frame of Reference Frame of Reference M

Equipment General Equipment M

General Image M

Image Plane M

Image Pixel MContrast/bolus C

Cine C

Multi-Frame C

CT Image M

Overlay Plane U

Modality LUT U

VOI LUT U

Approval U

Curve U

Audio U

Image

SOP Common M

CTCT--ImageImage IOD Module TableIOD Module Table


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CTCT--image attributesimage attributes

Tag value VR Value DICOM name(0008,0060) CS [CT] Modality

(0028,0030) DS [0.9375\0.9375] PixelSpacing

(0020,0032) DS [0.00\0.00\-912.12] ImagePositionPatient

(0028,0010) US 512 Rows

(0028,0011) US 512 Columns

(7fe0,0010) OW 03e8\007e\005b\0067\006e\0066\0057... PixelData

(0028,0101) US 12 BitsStored

Image Plane

Image Pixel

CT Image


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= information flow


AcquisitionCT-image

Therapist


Doctor

MLC fieldsRT-Plan


DRR'sRT-Image

Therapist


Auto / Physicist




Auto / Physicist


Therapist





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= information flow


AcquisitionCT-image

Therapist


Doctor

MLC fieldsRT-Plan


DRR'sRT-Image

Therapist


Auto / Physicist




Auto / Physicist


Therapist





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Organs localizationOrgans localization

Contouring ofContouring of

GTVGTV

Organs at riskOrgans at risk


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Organs localizationOrgans localization

GTV +GTV +

Organs at risksOrgans at risks

=> Same object=> Same object

RTRT--StructureSetStructureSet


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Entity Name Module Name UsagePatient Patient M

Study MStudy

Patient Study U

Series RT Series M


Structure Set MROI contour M

RT ROI Observations M

Approval U

Audio U

RT Structure Set

SOP Common M

RTRT--StructureSetStructureSet IOD Module TableIOD Module Table


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Tag value VR Value DICOM name

(0008,0060) CS [RTSTRUCT] Modality

(3006,0022) IS [0] or [1] or [2] ROINumber

(3006,0026) LO [Prostate] ROIName

(3006,002a) IS [255\255\255] ROIDisplayColor

(3006,0042) CS [CLOSED_PLANAR] ContourGeometr icType

(3006,0046) IS [47] NumberOfContourPoints

(3006,0050) DS

[161.25\318.75\-804.50\158.44\318.75\-804.50

\120.00\309.38\-804.50\160.31\317.81\-804.50]

ContourData

(3006,00a4)CS

[PTV] or [CTV] or [GTV] or[ORGAN] or [AVOIDANCE] or

[EXTERNAL] or [BOLUS] or[CONTRAST_AGENT]

RTROIInterpretedType

RTRT--StructureSet attributesStructureSet attributes

Structure Set

ROI Contour

RT ROI Observation

Squence

x y z


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= information flow


AcquisitionCT-image

Therapist


Doctor

MLC fieldsRT-Plan


DRR'sRT-Image

Therapist


Auto / Physicist




Auto / Physicist


Therapist





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= information flow


AcquisitionCT-image

Therapist


Doctor

MLC fieldsRT-Plan


DRR'sRT-Image

Therapist


Auto / Physicist




Auto / Physicist


Therapist





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Fields simulationFields simulation

ObjectObject RTRT--PlanPlan


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Patient Patient M

Study MStudy

Patient Study U

Series RT Series M


RT General Plan M

RT prescription URT Tolerance Tables U

RT Patient Setup U

RT Fraction Scheme U

RT Beams C

RT Brachy Application Setups C

Approval UAudio U

Plan

SOP Common M

RTRT--PlanPlan IOD Module TableIOD Module Table

Geometry in


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Example 1:Example 1:

Standard 10x10 AP 6MV beamStandard 10x10 AP 6MV beam


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(300a,0111) SQ (Sequence with explicit Length #=2) # ControlPointSequence

(300a,0112) IS [0] # ControlPointIndex(300a,0114) DS [6] # NominalBeamEnergy

(300a,011a) SQ (Sequence with explicit Length #=2) # BeamLimitingDevicePositionSequence(300a,00b8) CS [ASYMX] # RTBeamLimitingDeviceType(300a,011c) DS [-50.0\50.0] # LeafJawPositions

(300a,00b8) CS [ASYMY] # RTBeamLimitingDeviceType(300a,011c) DS [-50.0\50.0] # LeafJawPositions

(300a,011e) DS [0.0] # GantryAngle(300a,0120) DS [0.0] # BeamLimitingDeviceAngle(300a,0122) DS [0.0] # PatientSupportAngle(300a,0134) DS [0.0] # CumulativeMetersetWeight

(300a,0112) IS [1] # ControlPointIndex(300a,0134) DS [100.0] # CumulativeMetersetWeigh


Sequence of 2 control points:Sequence of 2 control points:

RTRT--Plan Beams ModulePlan Beams Module


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Control Point 0: Setup the geometry of the beamControl Point 0: Setup the geometry of the beam




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Control Point 1: Deliver irradiationControl Point 1: Deliver irradiation




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Example 2:Example 2:

3 segments3 segments Step and Shoot IMRTStep and Shoot IMRT1

2 3


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Step and Shoot IMRTStep and Shoot IMRTMachine capability:Machine capability:


(300a,00b6) SQ (Sequence with explicit Length #=3) # BeamLimitingDeviceSequence(300a,00b8) CS [ASYMX] # RTBeamLimitingDeviceType(300a,00bc) IS [1] # NumberOfLeafJawPairs(300a,00b8) CS [ASYMY] # RTBeamLimitingDeviceType(300a,00bc) IS [1] # NumberOfLeafJawPairs(300a,00b8) CS [MLCX] # RTBeamLimitingDeviceType(300a,00bc) IS [40] # NumberOfLeafJawPairs(300a,00be) DS [-200.0\-190.0\-180.0\-170.0\-160.0\

-150.0\-140.0\-130.0\-120.0\-110.0\

-100.0\-90.0\-80.0\-70.0\-60.0\-50.0\-40.0\-30.0\-20.0\-10.0\

0.0\10.00\20.00\30.00\40.00\50.00\60.00\70.00\80.00\90.00\100.0\110.0\120.0\130.0\140.0\150.0\160.0\170.0\180.0\190.0\200.0] # LeafPositionBoundaries

(300a,00c4) CS [STATIC] # BeamType(300a,00c6) CS [PHOTON] # RadiationType(300a,00d0) IS [0] # NumberOfWedges(300a,00e0) IS [0] # NumberOfCompensators(300a,00ed) IS [0] # NumberOfBoli

(300a,00f0) IS [0] # NumberOfBlocks(300a,0110) IS [5] # NumberOfControlPoints



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-150.0\-140.0\-130.0\-120.0\-110.0\

-100.0\-90.0\-80.0\-70.0\-60.0\-50.0\-40.0\-30.0\-20.0\-10.0\





Step and Shoot IMRTStep and Shoot IMRTMachine capability: Jaws & MLCMachine capability: Jaws & MLC



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-150.0\-140.0\-130.0\-120.0\-110.0\

-100.0\-90.0\-80.0\-70.0\-60.0\-50.0\-40.0\-30.0\-20.0\-10.0\





Step and Shoot IMRTStep and Shoot IMRTMachine capability: ModalitiesMachine capability: Modalities


3 segments


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(300a,0112) IS [0] # ControlPointIndex(300a,0114) DS [6.0] # NominalBeamEnergy

(300a,011a) SQ (Sequence with explicit Length #=3) # BeamLimitingDevicePositionSequence(300a,00b8) CS [ASYMX] # RTBeamLimitingDeviceType(300a,011c) DS [-60.0\60.0] # LeafJawPositions(300a,00b8) CS [ASYMY] # RTBeamLimitingDeviceType(300a,011c) DS [-45.0\45.0] # LeafJawPositions(300a,00b8) CS [MLCX] # RTBeamLimitingDeviceType(300a,011c) DS [0.0\0.0\0.0\0.0\-0.0\...

\-60.0\-55.1\-45.0\-41.2\-32.5\ \32.5\41.2\45.0\55.1\60.0\

0.0\0.0\0.0\0.0\0.0] # LeafJawPositions

(300a,011e) DS [180.0] # GantryAngle(300a,011f) CS [NONE] # GantryRotationDirection(300a,0120) DS [0.0] # BeamLimitingDeviceAngle(300a,0121) CS [NONE] # BeamLimitingDeviceRotationDirection(300a,0122) DS [0.0] # PatientSupportAngle

(300a,0123) CS [NONE] # PatientSupportRotationDirection(300a,0125) DS [0.0] # TableTopEccentricAngle(300a,0126) CS [NONE] # TableTopEccentricRotationDirection(300a,0128) DS (no value available) # TableTopVerticalPosition(300a,0129) DS (no value available) # TableTopLongitudinalPosition(300a,012a) DS (no value available) # TableTopLateralPosition

(300a,0134) DS [0.0] # CumulativeMetersetWeight

(300a,0112) IS [1] # ControlPointIndex(300a,0134) DS [0.290] # CumulativeMetersetWeight

1st segment: CP0 & CP11st segment: CP0 & CP1

Step and Shoot IMRTStep and Shoot IMRT



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\-60.0\-55.1\-45.0\-41.2\-32.5\ \32.5\41.2\45.0\55.1\60.0\








Control Point 0: Setup the geometry of 1st segmentControl Point 0: Setup the geometry of 1st segment


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\-60.0\-55.1\-45.0\-41.2\-32.5\ \32.5\41.2\45.0\55.1\60.0\








Control Point 1: Deliver irradiation w/o movementsControl Point 1: Deliver irradiation w/o movements

S d Sh IMRT


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Segments 2&3: CP2, CP3, CP4 & CP5Segments 2&3: CP2, CP3, CP4 & CP5(300a,0112) IS [2] # ControlPointIndex(300a,011a) SQ (Sequence with explicit Length #=3) # BeamLimitingDevicePositionSequence(300a,00b8) CS [ASYMX] # RTBeamLimitingDeviceType(300a,011c) DS [-60.0\-5.0] # LeafJawPositions(300a,00b8) CS [ASYMY] # RTBeamLimitingDeviceType(300a,011c) DS [-45.0\45.0] # LeafJawPositions(300a,00b8) CS [MLCX] # RTBeamLimitingDeviceType(300a,011c) DS [0.0\0.0\0.0\0.0\-0.0\...

\-60.0\-55.1\-45.0\-41.2\-32.5\ \-5.1\-5.5\-8.2\-10.3\-10.9\ 0.0\0.0\0.0\0.0\0.0] # LeafJawPositions



(300a,0112) IS [4] # ControlPointIndex(300a,011a) SQ (Sequence with explicit Length #=3) # BeamLimitingDevicePositionSequence(300a,00b8) CS [ASYMX] # RTBeamLimitingDeviceType(300a,011c) DS [-2.0\60.0] # LeafJawPositions(300a,00b8) CS [ASYMY] # RTBeamLimitingDeviceType(300a,011c) DS [-45.0\45.0] # LeafJawPositions(300a,00b8) CS [MLCX] # RTBeamLimitingDeviceType(300a,011c) DS [0.0\0.0\0.0\0.0\-0.0\...

\20.0\8.0\8.0\80\5.0\ \32.5\41.2\45.0\55.1\60.0\ 0.0\0.0\0.0\0.0\0.0] # LeafJawPositions



S d Sh IMRTSt d Sh t IMRT


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CP2 : Setup the geometry of segments 2CP2 : Setup the geometry of segments 2(300a,0112) IS [2] # ControlPointIndex(300a,011a) SQ (Sequence with explicit Length #=3) # BeamLimitingDevicePositionSequence(300a,00b8) CS [ASYMX] # RTBeamLimitingDeviceType(300a,011c) DS [-60.0\-5.0] # LeafJawPositions(300a,00b8) CS [ASYMY] # RTBeamLimitingDeviceType(300a,011c) DS [-45.0\45.0] # LeafJawPositions(300a,00b8) CS [MLCX] # RTBeamLimitingDeviceType(300a,011c) DS [0.0\0.0\0.0\0.0\-0.0\...








St d Sh t IMRTSt d Sh t IMRT


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CP2 & CP4 : Setup the geometry of segments 2 & 3CP2 & CP4 : Setup the geometry of segments 2 & 3(300a,0112) IS [2] # ControlPointIndex

(300a,011a) SQ (Sequence with explicit Length #=3) # BeamLimitingDevicePositionSequence(300a,00b8) CS [ASYMX] # RTBeamLimitingDeviceType(300a,011c) DS [-60.0\-5.0] # LeafJawPositions(300a,00b8) CS [ASYMY] # RTBeamLimitingDeviceType(300a,011c) DS [-45.0\45.0] # LeafJawPositions(300a,00b8) CS [MLCX] # RTBeamLimitingDeviceType(300a,011c) DS [0.0\0.0\0.0\0.0\-0.0\...








St d Sh t IMRTSt d Sh t IMRT


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CP3 & CP5 : Deliver irradiation w/o movementsCP3 & CP5 : Deliver irradiation w/o movements(300a,0112) IS [2] # ControlPointIndex

(300a,011a) SQ (Sequence with explicit Length #=3) # BeamLimitingDevicePositionSequence(300a,00b8) CS [ASYMX] # RTBeamLimitingDeviceType(300a,011c) DS [-60.0\-5.0] # LeafJawPositions(300a,00b8) CS [ASYMY] # RTBeamLimitingDeviceType(300a,011c) DS [-45.0\45.0] # LeafJawPositions(300a,00b8) CS [MLCX] # RTBeamLimitingDeviceType(300a,011c) DS [0.0\0.0\0.0\0.0\-0.0\...








RTRT PlPl IOD M d l T blIOD M d l T bl


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Patient Study U

Series RT Series M


RT General Plan M

RT prescription URT Tolerance Tables U

RT Patient Setup U

RT Fraction Scheme U

RT Beams C

RT Brachy Application Setups C

Approval UAudio U

Plan

SOP Common M

RTRT--PlanPlan IOD Module TableIOD Module Table

Dosimetry in

RTRT Pl d i tPl d i t


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(300a,0070) SQ (Sequence with explicit Length #=1) # FractionGroupSequence(300a,0071) IS [1] # FractionGroupNumber(300a,0078) IS [35] # NumberOfFractionsPlanned(300a,0080) IS [2] # NumberOfBeams

(300c,0004) SQ (Sequence with explicit Length #=2) # ReferencedBeamSequence(300a,0082) DS [230.6\241.2\-1270.4] # BeamDoseSpecificationPoint(300a,0084) DS [1.000] # BeamDose(300a,0086) DS [102.5] # BeamMeterset(300c,0006) IS [1] # ReferencedBeamNumber

(300a,0082) DS [230.6\241.2\-1270.4] # BeamDoseSpecificationPoint(300a,0084) DS [1.000] # BeamDose(300a,0086) DS [97.5] # BeamMeterset

(300c,0006) IS [2] # ReferencedBeamNumber

RTRT--Plan dosimetryPlan dosimetry

1) Beams1) Beams dosimetrydosimetry

RTRT--Plan Fraction scheme ModulePlan Fraction scheme Module

RTRT Pl d i tPlan dosimetry


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Number of fractionsNumber of fractions


RTRT Plan dosimetryPlan dosimetry


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Number of beams (example: APNumber of beams (example: AP--PA)PA)




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Beam 1Beam 1 --> 1Gy / 102.5 MU> 1Gy / 102.5 MU


AP



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Beam 1Beam 1 --> 1Gy / 102.5 MU> 1Gy / 102.5 MU Beam 2Beam 2 --> 1Gy / 97.5 MU> 1Gy / 97.5 MU


PA



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(300a,0010) SQ (Sequence with explicit Length #=2) # DoseReferenceSequence(300a,0012) IS [1] # DoseReferenceNumber(300a,0014) CS [COORDINATES] # DoseReferenceStructureType(300a,0016) LO [ICRU point] # DoseReferenceDescription(300a,0018) DS [230.6\241.2\-1270.4] # DoseReferencePointCoordinates

(300a,0020) CS [TARGET] # DoseReferenceType(300a,002c) DS [70.0] # TargetMaximumDose

(300a,0012) IS [2] # DoseReferenceNumber(300a,0014) CS [COORDINATES] # DoseReferenceStructureType(300a,0016) LO [Bladder] # DoseReferenceDescription(300a,0018) DS [225.1\198.6\-1275.3] # DoseReferencePointCoordinates(300a,0020) CS [ORGAN_AT_RISK] # DoseReferenceType(300a,002c) DS [45.0] # OrganAtRiskMaximumDose


2) Definition of reference dose points2) Definition of reference dose points

RTRT--Plan Prescription ModulePlan Prescription Module



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(300a,0010) SQ (Sequence with explicit Length #=2) # DoseReferenceSequence(300a,0012) IS [1] # DoseReferenceNumber(300a,0014) CS [COORDINATES] # DoseReferenceStructureType(300a,0016) LO [ICRU point] # DoseReferenceDescription(300a,0018) DS [230.6\241.2\-1270.4] # DoseReferencePointCoordinates

(300a,0020) CS [TARGET] # DoseReferenceType(300a,002c) DS [70.0] # TargetMaximumDose

(300a,0012) IS [2] # DoseReferenceNumber(300a,0014) CS [COORDINATES] # DoseReferenceStructureType(300a,0016) LO [Bladder] # DoseReferenceDescription(300a,0018) DS [225.1\198.6\-1275.3] # DoseReferencePointCoordinates(300a,0020) CS [ORGAN_AT_RISK] # DoseReferenceType(300a,002c) DS [45.0] # OrganAtRiskMaximumDose


2) Definition of reference dose points2) Definition of reference dose points

1. ICRU1. ICRU 2. Bladder2. Bladder

RTRT--Plan Prescription ModulePlan Prescription Module

RTRT-Plan dosimetryPlan dosimetry


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Use the control points conceptUse the control points concept


ROM ODULE RT-PLAN FRACTION Sc EME:

(300a,0084) DS [1.000] # BeamDose(300a,0086) DS [102.5] # BeamMeterset

FROM MODULE RT-PLAN BEAMS:

(300a,010e) DS [100.0] # FinalCumulativeMetersetWeight(300a,0111) SQ (Sequence with explicit Length #=2) # ControlPointSequence

(300a,0112) IS [0] # ControlPointIndex(300a,0134) DS [0.0] # CumulativeMetersetWeight(300c,0050) SQ (Sequence with explicit Length #=2) # ReferencedDoseReferenceSequence(300a,010c) DS [0.000] # CumulativeDoseReferenceCoefficient(300c,0051) IS [1] # ReferencedDoseReferenceNumber(300a,010c) DS [0.000] # CumulativeDoseReferenceCoefficient(300c,0051) IS [2] # ReferencedDoseReferenceNumber


RTRT--Plan EntityPlan Entity



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1. For each beam, dose in1. For each beam, dose in GyGy andand MUsMUs are givenare given


AP



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2. @CP0: The cumulative coefficients are set to 02. @CP0: The cumulative coefficients are set to 0




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(300a,0112) IS [0] # ControlPointIndex

(300a,0134) DS [0.0] # CumulativeMetersetWeight(300c,0050) SQ (Sequence with explicit Length #=2) # ReferencedDoseReferenceSequence(300a,010c) DS [0.000] # CumulativeDoseReferenceCoefficient(300c,0051) IS [1] # ReferencedDoseReferenceNumber(300a,010c) DS [0.000] # CumulativeDoseReferenceCoefficient(300c,0051) IS [2] # ReferencedDoseReferenceNumber


2. @CP1: MU given = 102.5 / 100.0 x 20.0 = 20.52. @CP1: MU given = 102.5 / 100.0 x 20.0 = 20.5




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2. @CP1: Dose @ pt1 = 1.000 x 0.200 = 0.22. @CP1: Dose @ pt1 = 1.000 x 0.200 = 0.2 GyGy




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2. @CP1: Dose @ pt2 = 1.000 x 0.122 = 0.1222. @CP1: Dose @ pt2 = 1.000 x 0.122 = 0.122 GyGy




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FROM MODULE RT-PLAN FRACTION ScHEME:






(300a,0112) IS [N-1] # ControlPointIndex(300a,0134) DS [100.0] # CumulativeMetersetWeight(300c,0050) SQ (Sequence with explicit Length #=2) # ReferencedDoseReferenceSequence(300a,010c) DS [1.000] # CumulativeDoseReferenceCoefficient(300c,0051) IS [1] # ReferencedDoseReferenceNumber(300a,010c) DS [0.641] # CumulativeDoseReferenceCoefficient(300c,0051) IS [2] # eferencedDoseReferenceNumber

RTRT Plan dosimetryPlan dosimetry3. @CPN3. @CPN--1: MU given = 102.5 / 100.0 x100.0 = 102.51: MU given = 102.5 / 100.0 x100.0 = 102.5




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RTRT Plan dosimetryPlan dosimetry3. @CPN3. @CPN--1: Dose @ pt1 = 1.000 x 1.000 = 11: Dose @ pt1 = 1.000 x 1.000 = 1 GyGy




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RTRT Plan dosimetryPlan dosimetry3. @CPN3. @CPN--1: Dose @ pt2 = 1.000 x 0.641 = 0.6411: Dose @ pt2 = 1.000 x 0.641 = 0.641 GyGy




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= information flow

o o @ C@PQ5000 AcQSim AcQplan Router Precise linac iView ACTORS

AcquisitionCT-image

Therapist


Doctor

MLC fieldsRT-Plan


DRR's

RT-ImageTherapist


Auto / Physicist




Auto / Physicist

Treatment

RT-TrtRecord

Therapist






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= information flow

@@PQ5000 AcQSim AcQplan Router Precise linac iView ACTORS

AcquisitionCT-image

Therapist


Doctor

MLC fieldsRT-Plan


DRR's

RT-ImageTherapist


Auto / Physicist




Auto / Physicist

Treatment

RT-TrtRecord

Therapist




Simulation imagesSimulation images


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gg

DRRDRRs :s :

Serie of objectsSerie of objects

RTRT--ImageImage

RTRT--ImageImage IOD Module TableIOD Module Table


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gg



Patient Study U

Series RT Series M

Frame of Reference Frame of Reference U


General Image M

Image Pixel M

Contrast/bolus C

Cine C

Multi-Frame C

RT Image M

Modality LUT U

VOI LUT U

Approval U

Curve UAudio U

Image

SOP Common M

RTRT--Image pixel moduleImage pixel module


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g pg pTag value VR Value DICOM name

(0008,0060) CS [RTIMAGE] Modality

(3002,0012) DS [-80.99\80.99] RTImagePosition

(3002,0011) DS [0.32\0.32] ImagePlanePixelSpacing

(0028,0010) US 512 Rows

(0028,0011) US 512 Columns


(7fe0,0010) OW ffff\8cff\8d8d\ \bebe\bebe\65be PixelData

Visualization of the RTVisualization of the RT--Image IODImage IOD


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More than a greyscale image

RTRT--ImageImage IOD Module TableIOD Module Table


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g



Patient Study U

Series RT Series M

Frame of Reference Frame of Reference U


General Image M

Image Pixel M

Contrast/bolus C

Cine C

Multi-Frame C

RT Image M

Modality LUT U

VOI LUT U

Approval U

Curve UAudio U

Image

SOP Common M

1: Jaws aperture1: Jaws aperture


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(300a,00b8) CS [ASYMX] # RTBeamLimitingDeviceType

(300a,00ba) DS [396.00] # SourceToBeamLimitingDeviceDistance

(300a,00bc) IS [1] # NumberOfLeafJawPairs

(300a,011c) DS [-60.00\60.00] # LeafJawPositions

(300a,00b8) CS [ASYMY] # RTBeamLimitingDeviceType

(300a,00ba) DS [470.00] # SourceToBeamLimitingDeviceDistance(300a,00bc) IS [1] # NumberOfLeafJawPairs

(300a,011c) DS [-50.00\50.00] # LeafJawPositions

RTRT--Image moduleImage module

1: Jaws aperture1: Jaws aperture


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(5004,0005) US 2 # CurveDimensions

(5004,0010) US 5 # NumberOfPoints

(5004,0020) CS [ROI] # TypeOfData

(5004,0022) LO [Beam:ANT SF:00ff9a00] # CurveDescription

(5004,0030) SH [PIXL\PIXL] # AxisUnits(5004,0103) US 1 # DataValueRepresentation

(5004,3000) ox 62\00\84\\62\00\84\01 # CurveData

or Curve moduleor Curve module

2: MLC aperture2: MLC aperture

(300a,00b8) CS [MLCX] # RTBeamLimitingDeviceType



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(300a,00bc) IS [40] # NumberOfLeafJawPairs

(300a,00be) DS [-200.00\-190.00\\190.00\200.00] # LeafPositionBoundaries

(300a,011c) DS [\60.00\60.00\58.00\56.00\] # LeafJawPositions

RTRT--Image moduleImage module

2: MLC aperture2: MLC aperture(5002,0005) US 2 # CurveDimensions


(5002,0020) CS [ROI] # TypeOfData


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or Curve moduleor Curve module

(5002,0022) LO [MLC:MLC:0000ff7a] # CurveDescription

(5002,0030) SH [PIXL\PIXL] # AxisUnits

(5002,0103) US 1 # DataValueRepresentation

(5002,3000) ox 9e\01\7c\\9e\01\7c\00 # CurveData

3: Axis and image center3: Axis and image center

Only Curve moduleOnly Curve module


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(5006,0020) CS [POLY] # TypeOfData

(5006,0022) LO [Axis:X Axis:00ff9a00 # CurveDescription(5006,0030) SH [PIXL\PIXL] # AxisUnits


(5006,3000) ox 13\00\00\01\ed\01\00\01 # CurveData



(5008,0020) CS [POLY] # TypeOfData

(5008,0022) LO [Axis:Y Axis:00ff9a00] # CurveDescription

(5008,0030) SH [PIXL\PIXL] # AxisUnits


(5008,3000) ox 00\01\ed\01\00\01\13\00 # CurveData



RT Workflow @ HCFRT Workflow @ HCFPQ 000 A QSi A Q l R P i li iVi ACTORS


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= information flow


AcquisitionCT-image

Therapist


Doctor

MLC fieldsRT-Plan


DRR'sRT-Image

Therapist


Auto / Physicist




Auto / Physicist


Therapist




RT Workflow @ HCFRT Workflow @ HCFPQ5000 A QSi A Q l R t P i li iVi ACTORS


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= information flow


AcquisitionCT-image

Therapist


Doctor

MLC fieldsRT-Plan


DRR'sRT-Image

Therapist


Auto / Physicist




Auto / Physicist


Therapist




Dose distributionDose distribution


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Dose matrixDose matrix

Isodose curvesIsodose curves

Isodose surfaceIsodose surface

DVHDVH

=>=>

1 object1 object RTRT--DoseDose

RTRT--DoseDose IOD Module TableIOD Module Table


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Patient Patient M

Study MStudyPatient Study U

Series General Series M

Frame of Reference Frame of Reference M


General Image C

Image plane C

Image Pixel C

Multi-Frame CRT Dose M

RT DVH U

Structure Set C

ROI contour C

RT Dose ROI C

Overlay Plan U

Multi-frame Overlay U

Audio UModality LUT U

Dose

SOP Common M

Dose matrix

RTRT--Dose attributesDose attributes


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Tag value VR Value DICOM name

(0008,0060) CS [RTDOSE] Modality(0028,0030) DS [2.50\2.50] PixelSpacing

(0020,0032) DS [49.51\99.51\-1487.12] ImagePositionPatient

(0028,0010) US 109 Rows

(0028,0011) US 154 Columns

(7fe0,0010) OW fc80\000a\67c8\000c\4670\000d\09c0\000e... PixelData

(0028,0008) IS [76] NumberOfFrames


(3004,0002) CS [GY] or [RELATIVE] DoseUnits

(3004,0004) CS [PHYSICAL] or [EFFECTIVE] or [ERROR] DoseType

(3004,000a) CS [FRACTION] or [BEAM] or [PLAN] DoseSummationType

(3004,000c) DS 0.00\3.00\6.00\9.00\12.00...216.00\219.00\222.00\225.00

GridFrameOffsetVector

(3004,000e)] DS [.000000989] DoseGridScaling

Image Plane

Image Pixel

Frame of Reference

RT Dose



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= information flow


Acquisition

CT-image

Therapist


Doctor

MLC fieldsRT-Plan


DRR'sRT-Image

Therapist


Auto / Physicist




Auto / Physicist


Therapist






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= information flow

p

Acquisition

CT-image

Therapist


Doctor

MLC fieldsRT-Plan


DRR'sRT-Image

Therapist


Auto / Physicist




Auto / Physicist


Therapist




Treatment deliveryTreatment delivery


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ObjectObject RTRT--PlanPlan => linac DB=> linac DB

Treatment deliveryTreatment delivery


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ObjectObject RTRT--TrtTrt--RecordRecord => printer=> printer



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= information flow

Acquisition

CT-image

Therapist


Doctor

MLC fieldsRT-Plan


DRR'sRT-Image

Therapist


Auto / Physicist




Auto / Physicist


Therapist






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= information flow

Acquisition

CT-image

Therapist


Doctor

MLC fieldsRT-Plan


DRR'sRT-Image

Therapist


Auto / Physicist




Auto / Physicist


Therapist




Electronic Portal ImagingElectronic Portal Imaging

i f bji f bj t RTRT I I


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= serie of objects= serie of objects RTRT--ImagesImages

Portal

DRR

Verification by

contour matching



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= information flow

Acquisition

CT-image

Therapist


Doctor

MLC fieldsRT-Plan


DRR'sRT-Image

Therapist


Auto / Physicist




Auto / Physicist


Therapist




Physicists conclusionsPhysicists conclusions


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Learn DICOM terminologyLearn DICOM terminology

Describe your clinics workflowDescribe your clinics workflow

Look at physical attributes mappingLook at physical attributes mapping

Motivate and train all the actorsMotivate and train all the actors

Establish electronic QAEstablish electronic QA

The Clinical Physics Aspects Behind DICOM-RT, Germond

Documents